While the COVID-19 pandemic presents a host of significant health, social, and economic challenges for millions of Americans, individuals experiencing homelessness are particularly vulnerable to the virus. Factors such as high rates of chronic conditions, congregate sheltering options, and limited ability for complying with federal and state public health guidance, all increase the risk of infection in this population. In the midst of this pandemic, these immediate concerns are further compounded by homeless individuals’ already tenuous access to consistent health care services.

Where is this happening? Although homelessness is a national issue, individuals experiencing homelessness are typically in urban areas with nearly half of Americans experiencing homelessness residing in California, New York, or Florida. Cities with high numbers of homeless individuals such as San Francisco, Los Angeles, and New York City are particularly strained in the current environment to identify alternative shelter options, provide health care resources to limit COVID-19 infection spread, and isolate individuals who have tested positive for the disease. Ensuring that individuals who are homeless have access to health care services for ongoing health conditions such as substance use disorder and diabetes, among many others, is already a challenge and COVID-19 further amplifies the issues.

What has been done so far? In the first few weeks of the pandemic, activities at the federal, state, and local policy levels were implemented to increase flexibilities, protections, and funding to support individuals experiencing homelessness. These efforts have largely focused on addressing the shelter needs of this population (e.g., increasing shelter capacity, temporarily halting evictions, or identifying unique, temporary housing options) and mitigating their COVID-19 infection risks. Similarly, there are multiple federal-, state-, and county-level guidance documents and assessment tools available for providers, agencies, and organizations that serve individuals experiencing homelessness. In addition to policy strategies, there are examples of organizations modifying or enhancing service delivery for this population, including: use of mobile medical teams and leveraging new technology to track the health of homeless individuals and others who are unable to shelter at home.

What is the current status? Agencies and organizations providing services to this population typically have emergency protocols in place, but there is broad variation in how states and local governments are approaching the issue new guidance forthcoming with the loosening of social distancing restrictions. There are also a growing number of innovative strategies occurring at the community level to address immediate needs. Recent examples include: (1) preliminary research about universal testing; (2) cross-sector collaborations to donate and coordinate personal protective equipment for frontline staff; (3) development of financial assistance funds for individuals at risk of becoming homeless during the pandemic; and (4) partnerships to deploy grant funds to local organizations. Likewise, previous disease outbreaks affecting this population can also provide important historical lessons from stakeholders that can inform current approaches to the COVID-19 pandemic.

Moving Forward to Support People who are Homeless amid COVID-19

Over the coming weeks and months, priorities for addressing the health care needs of the homeless population affected by COVID-19 will shift from preventing and treating the disease to mitigating the long-term effects on these individuals’ pre-existing health conditions—some of which may be further exacerbated—in this new landscape. The rapidly changing impact of the virus has required leaders, organizations, and on-the-ground teams to continually evolve their approaches as the local impact rises, spikes, and begins to ebb. There are also multiple factors and a growing body of information about policy, financing, and operational options available to government agencies and community-based organizations.

Given the vulnerabilities of people experiencing homelessness to COVID-19, it is valuable to share real-time lessons that are emerging across the country regarding how to meet the health care needs of this population during the pandemic. In partnership with the California Health Care Foundation, the Center for Health Care Strategies (CHCS) will be sharing considerations and emerging lessons based on experiences of stakeholders across the country over the coming months. These resources will be aimed at supporting stakeholders at state and local levels (e.g., delivery systems, community-based organizations, policymakers, etc.), and will focus on identifying promising practices, learning from stakeholders and partners across the country, and exploring long-term, sustainable solutions. CHCS also intends to support a learning collaborative to connect California stakeholders seeking to improve health care for people in need of shelter.

A Call for Ideas

These new resources will highlight the firsthand experience of organizations across the nation doing the important work of supporting homeless individuals during the pandemic. If you’re a provider or organization providing services to homeless individuals and have questions, resources or approaches to share, we’d like to hear from you. Please leave a comment below or reach out to us via email at: homelessCOVID-19@chcs.org.

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